Texas Heart Institute journal
-
Case Reports
Percutaneous thrombin injection of common carotid artery pseudoaneurysm without cerebral protection.
An 83-year-old man with sepsis sustained right common carotid artery injury during attempted central-line placement. A computed tomographic scan showed a large hematoma in the patient's neck and a carotid pseudoaneurysm. His clinical condition was such that transfer to the interventional suite was judged unsafe. ⋯ The procedure was successful, with no neurologic complications. At follow-up ultrasonographic evaluation, there was complete and sustained occlusion of the pseudoaneurysm. Emergent percutaneous treatment of common carotid artery pseudoaneurysm can be performed without temporary balloon occlusion for cerebral protection-in extreme circumstances, and at unknown risk.
-
Peripartum cardiomyopathy is idiopathic heart failure occurring in the absence of any determinable heart disease during the last month of pregnancy or the first 5 months postpartum. The incidence varies worldwide but is high in developing nations; the cause of the disease might be a combination of environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction <0.45 or M-mode fractional shortening <30% (or both) and end-diastolic dimension >2.7 cm/m(2). ⋯ Mechanical support and transplantation might be necessary in severe cases. Targeted therapies (such as intravenous immunoglobulin, pentoxifylline, and bromocriptine) have shown promise in small trials but require further evaluation. Fortunately, despite a mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset.
-
In patients with ST-elevation myocardial infarction, delay in door-to-balloon time strongly increases mortality rates. To our knowledge, no randomized studies to date have focused on reducing delays within the catheterization laboratory. We performed a retrospective analysis of all patients who presented with ST-elevation myocardial infarction at our institution from July 2006 through June 2010, looking primarily at time differences between percutaneous coronary intervention in the culprit vessel on the basis of ECG criteria, followed by contralateral angiography (Group 1), versus complete coronary angiography followed by culprit-vessel percutaneous intervention (Group 2). ⋯ There were no differences in mortality rate or ejection fraction at the median 1-year follow-up. Four patients in Group 1 and 3 patients in Group 2 were referred for coronary artery bypass grafting after percutaneous intervention. This study suggests that performing culprit-vessel percutaneous intervention on the basis of electrocardiographic criteria, followed by angiography in patients with anterior ST-elevation myocardial infarction, might be the preferred approach, given the door-to-balloon time that is saved.